Vitiligo
is a condition in which you lose the pigment of your skin. Pigment, or melanin, causes
skin color and is produced by cells called “melanocytes.”

Most people with vitiligo lose pigment in patches of
normally pigmented skin, which is replaced by flat, white patches with
irregular borders. This loss of pigmentation can occur in small patches on one
side of the body or in large areas covering over 50 percent of the body. These
patches are usually areas of your body that are exposed to the sun, such as
your:

hands

face

arms

feet

However, your genitalia can also be affected.

Vitiligo
can be treated but not cured. You’ll need to manage the disorder throughout
your life. The National Vitiligo
Foundation estimates that 0.5 to 1 percent of the general population has
vitiligo.

The
condition isn’t contagious, doesn’t cause pain, and isn’t medically dangerous.
Vitiligo affects males and females of all races equally. The loss of pigment,
called depigmentation, is more
noticeable in people with dark skin.

What Causes Vitiligo?

The exact cause of vitiligo is unknown, according to the National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Researchers think that vitiligo could be an autoimmune response, meaning that
the body attacks itself. In this case, your body destroys its own melanocytes
so that the pigment is lost. Vitiligo also appears to be an inherited
condition. Up to 30 percent of people
who have vitiligo have a family member with the same condition.

Symptoms of Vitiligo

The main symptom of vitiligo is the absence of pigment on
the skin. Three different patterns of depigmentation are possible:

In a focal
pattern, the loss of skin color appears in only a few small areas.

In a segmental
pattern, depigmentation occurs on one side of the body.

In a generalized
pattern, the loss of melanin occurs on both sides of the body in a
symmetrical pattern.

The generalized pattern is the most common type of
vitiligo. Depigmentation in any of the three patterns can appear on your:

face

arms

underarms

legs

hands

feet

lips

groin

The lining of the inside of your mouth may also lose
color.

Premature graying of scalp and facial hair can also be a
sign of vitiligo. This includes your eyebrows and eyelashes.

Diagnosing Vitiligo

Your
doctor will review your medical history and possibly test a skin sample to
diagnose vitiligo. Family history of the condition and reports of sunburns or
blistering are considered. According to the NIAMS, sun damage
may trigger vitiligo symptoms in some patients. A skin biopsy can reveal the
complete absence of pigment and may confirm the diagnosis.

Your doctor might also run blood tests to check your
vitamin B-12 levels and thyroid function. An overactive thyroid and a
deficiency of B-12 are often associated with vitiligo. Running these tests can
help you get prompt treatment for any related conditions if needed.

Treatment and Management

Vitiligo is painless and benign. The goal of treatment is
to restore pigment to your skin, which is cosmetic. Treating vitiligo is a
long-term commitment. Most therapies don’t show results for several months.
Treatments include the following:

Steroids

Topical medications can be effective ways to repigment the
white patches of skin. Topical steroid medications are used in children and
adults. Steroids must be applied to the skin daily for at least three months
before you can expect to see results. Steroid creams can have some adverse
effects, including a thinning of the skin or streaks of color on the skin.

Immunomodulators

Another
group of drugs called immunomodulators may
also treat vitiligo. These are ointments that contain the active ingredient
tacrolimus or pimecrolimus. According
to the Mayo Clinic, people who
have small areas of pigment loss on the face and neck usually see results with
immunomodulators.

Ultraviolet Light

Ultraviolet light therapy can restore pigment in some
people with vitiligo. Most often, you are required to take a medication called
psoralen, which causes the skin to be more sensitive to the light treatment.
Psoralen is available in both topical and oral forms. The combination of
psoralen and UVA rays is called PUVA treatment. It darkens the light areas of your
skin.

Since you’re more sensitive to sunlight when using psoralen,
you should protect the rest of your body with sunscreen. You can get PUVA
treatment several times per week in your doctor’s office.

Depigmentation

When
repigmentation of the white patches fails, depigmenting the rest of your body
is another treatment option. Depigmentation is
reserved for those who present with vitiligo on more than half of their body.
The goal is to match your normal pigmented skin to the areas affected by
vitiligo.

A medication called monobenzone is applied to your skin to
lighten the pigmented areas. This topical medication can bleach the skin of
other people who may come into direct contact with you. Therefore, skin-to-skin
contact must be avoided for two hours after treatment.

Noninvasive
management of vitiligo can include makeup and sunless tanners. Tanning doesn’t
help restore pigment loss from vitiligo, according to the NIAMS. Tanning
makes the difference between normal and depigmented skin tone more obvious. You should
use sunscreen with UVA and UVB protection to protect your skin.

Surgery Options

In
severe cases, you may elect to have surgery to try to restore normal skin
tone. Skin grafting takes healthy
skin and places it in an area that has been affected by vitiligo. Such surgical
procedures are possibilities for people whose vitiligo hasn’t improved despite
several years of consistent treatment. The surgery is expensive, rarely covered
by insurance, and can cause scarring.

Support

Some people with vitiligo need help coping with their
emotional response to having a chronic skin condition. Ask your doctor for a
referral to a support group or mental health professional if you need support. Counselors
and your peers can also provide support.